Provider Demographics
NPI:1720676760
Name:RAYSON-HENRY, TANISHA JENEICE (FNP)
Entity type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:JENEICE
Last Name:RAYSON-HENRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TANISHA
Other - Middle Name:JENEICE
Other - Last Name:RAYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4051 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3009
Mailing Address - Country:US
Mailing Address - Phone:738-716-5167
Mailing Address - Fax:
Practice Address - Street 1:4051 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3009
Practice Address - Country:US
Practice Address - Phone:773-871-6516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily